Surgical strategy for intracranial hemorrhage with accidental hypothermia in elderly individuals

Accidental hypothermia poses a significant threat to the elderly, and its prevalence might increase due to aging and increasing isolation of individuals in Japan. Here, a series of four consecutive cases of accidental hypothermia in elderly patients with intracranial hemorrhage who underwent surgical treatment at our institution is presented. All patients were admitted to the emergency department with a diagnosis of intracranial hemorrhage. Among them, two patients experienced acute circulatory failure during emergency surgery, necessitating immediate cardiopulmonary resuscitation. Two other patients required intensive care before surgery; however, one of them exhibited signs of impending cerebral herniation, requiring emergency surgery. Accidental hypothermia poses a significant threat to elderly individuals, carrying a substantial mortality risk and demanding intensive general care. During rewarming, careful considerations must be devoted to potential complications, such as ventricular fibrillation, rewarming shock, bleeding diathesis, and hyperkalemia. Despite these risks, many life-threatening cases necessitate emergency surgery and rewarming procedures in parallel. The formulation of a surgical strategy aimed at mitigating rewarming-related complications should be entrusted to anesthesiologists. Strict follow-up is required to increase intracranial pressure when prioritizing intensive care over surgery.